MEDICARE: STARLA R LEETE APRN, CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	274	WY
2	176B00000X	Midwife	274	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922103431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STARLA R LEETE APRN, CNM

Provider Business Mailing Address
First Line	:	PO BOX 1359
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82902-1359
Country	:	US
Telephone Number	:	307-352-8383
Fax Number	:	307-352-8477

Provider Business Practice Location Address
First Line	:	1180 COLLEGE DR
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5863
Country	:	US
Telephone Number	:	307-352-8383
Fax Number	:	307-352-8477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	02/02/2022

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